Stephanie Shire

Isolating active ingredients in a parent-mediated social communication intervention for toddlers with autism spectrum disorder.

BACKGROUND Behavioral interventions are commonplace in the treatment of autism spectrum disorders, yet relatively little is known about how and why these interventions work. This study tests the relationship between isolated core components of a packaged social communication intervention and the primary outcome, joint engagement, to better understand how the intervention is affecting change in individuals. METHODS A total of 86 toddlers and their parents were enrolled in the study and randomized to one of two treatments, the joint attention, symbolic play, engagement, and regulation (JASPER) parent-mediated intervention or a psychoeducational intervention. Measures regarding the parents use of intervention strategies were collected before and after the 10-week intervention. Additional measures of child and parent joint engagement were also collected. RESULTS A significant effect of treatment was found for all four of the core strategies of the intervention, favoring a larger increase in the JASPER condition. A hierarchical linear regression revealed several individual predictors of joint engagement, including parent-rated buy-in, interventionist-rated parent involvement, and parental use of strategies. To complement the hierarchical analysis, we also tested the potential mediating effect the strategies may have on the relationship between treatment and joint engagement. Results showed that the strategy of mirrored pacing mediated the relationship between treatment and joint engagement in the positive direction. CONCLUSIONS These results strongly suggest that the mirrored pacing strategy is an active ingredient of the JASPER treatment.

Increasing Responsive Parent-Child Interactions and Joint Engagement: Comparing the Influence of Parent-Mediated Intervention and Parent Psychoeducation.

Enhancing immediate and contingent responding by caregivers to children’s signals is an important strategy to support social interactions between caregivers and their children with autism. Yet, there has been limited examination of parents’ responsive behaviour in association with children’s social behaviour post caregiver-mediated intervention. Eighty-five dyads were randomized to one of two 10-week caregiver-training interventions. Parent–child play interactions were coded for parental responsivity and children’s joint engagement. Significant gains in responsivity and time jointly engaged were found post JASPER parent-mediated intervention over a psychoeducation intervention. Further, combining higher levels of responsive behaviour with greater adoption of intervention strategies was associated with greater time jointly engaged. Findings encourage a focus on enhancing responsive behaviour in parent-mediated intervention models.

Does Gender Influence Core Deficits in ASD? An Investigation into Social-Communication and Play of Girls and Boys with ASD

Due to the predominance of boys diagnosed with autism spectrum disorders (ASD), girls are rarely studied independently. Research specifically focusing on play and social-communication in girls with ASD is extremely varied. We were interested in whether girls with ASD demonstrated equivalent social-communication and play skills in early childhood relative to boys, using two measures focused on the specific quantification of these variables. We also examined whether the associations between developmental variables and social-communication and play differed by gender. Forty girls with ASD were individually matched to 40 boys based on ASD severity. Our results suggest that girls and boys were more similar than different, however they also raise questions about the potential differential associations between development and requesting ability in girls and boys with ASD.

Longitudinal Effects of Adaptive Interventions With a Speech-Generating Device in Minimally Verbal Children With ASD

There are limited data on the effects of adaptive social communication interventions with a speech-generating device in autism. This study is the first to compare growth in communications outcomes among three adaptive interventions in school-age children with autism spectrum disorder (ASD) who are minimally verbal. Sixty-one children, ages 5–8 years, participated in a sequential, multiple-assignment randomized trial (SMART). All children received a developmental behavioral communication intervention: joint attention, symbolic play, engagement and regulation (JASP) with enhanced milieu teaching (EMT). The SMART included three 2-stage, 24-week adaptive interventions with different provisions of a speech-generating device (SGD) in the context of JASP+EMT. The first adaptive intervention, with no SGD, initially assigned JASP+EMT alone, then intensified JASP+EMT for slow responders. In the second adaptive intervention, slow responders to JASP+EMT were assigned JASP+EMT+SGD. The third adaptive intervention initially assigned JASP+EMT+SGD; then intensified JASP+EMT+SGD for slow responders. Analyses examined between-group differences in change in outcomes from baseline to Week 36. Verbal outcomes included spontaneous communicative utterances and novel words. Nonlinguistic communication outcomes included initiating joint attention and behavior regulation, and play. The adaptive intervention beginning with JASP+EMT+SGD was estimated as superior. There were significant (p < .05) between-group differences in change in spontaneous communicative utterances and initiating joint attention. School-age children with ASD who are minimally verbal make significant gains in communication outcomes with an adaptive intervention beginning with JASP+EMT+SGD. Future research should explore mediators and moderators of the adaptive intervention effects and second-stage intervention options that further capitalize on early gains in treatment.

Communication Partners Supporting Children With Complex Communication Needs Who Use AAC: A Systematic Review

Communication partners who efficiently use augmentative and alternative communication (AAC) are essential interaction partners for children learning to communicate using AAC. This systematic review examines studies targeting interventions designed to help communication partners support children with complex communication needs who use AAC. Overall, the 13 studies of moderate methodological quality rated using published rating scales reported positive findings for partners’ skills and children’s communication. Author-reported effect sizes and calculation of improvement rate difference indicated that multiple studies demonstrated large effects that were maintained 1 to 2 months post intervention. Delivery considerations for partner training including device training, enhancing partners’ understanding of communication targets, and the timing of partner training are discussed. The importance of supporting successful interactions across learning contexts and domains of communication as well as over time is highlighted. Furthermore, implications for dyads with unique characteristics including limited experience with AAC and children who are developmentally young are examined.

Train the trainer effectiveness trials of behavioral intervention for individuals with autism: a systematic review.

This systematic review examines train the trainer (TTT) effectiveness trials of behavioral interventions for individuals with autism spectrum disorder (ASD). Published methodological quality scales were used to assess studies including participant description, research design, intervention, outcomes, and analysis. Twelve studies including 9 weak quality quasi-experimental studies, 2 single-subject experimental design studies of moderate and weak quality, and 1 high quality randomized control trial were included. Overall, author reported effect sizes and calculation of improvement rate difference for SSRDs indicate positive effects of intervention across participant outcomes including cognition, language, and autism symptoms postcommunity delivered interventions primarily based in applied behavior analysis. Effects varied by childrens developmental level.

Social Communication Interventions

Initiations of social communication skills, including prelinguistic and spoken behavior to share and to request, are a core challenge for children with autism spectrum disorder (ASD). Prelinguistic behaviors including eye contact and gestures to request and to share (joint attention) are strongly associated with later language growth and, therefore, are a critical focus for children who are pre- or minimally verbal. Forty-one studies including randomized controlled trials (RCTs) and single-case designs (SCDs) examining social communication skills are reviewed in this chapter. On average, both RCTs and SCDs were of “moderate” methodological quality using published metrics for rating internal validity. Additional criteria to examine the external validity of the studies were also applied. Advances in external validity included specific recruitment of populations less frequently examined in research, delivery of intervention in community settings, and emergence of long-term follow-up studies. The studies were limited by assessment and reporting of composite social communication outcomes. Collapsing outcomes across behavioral form and function occludes understanding of which specific behaviors are changing over time. In studies in which outcomes are collapsed, lower level or simpler skills (e.g., responding to joint attention, eye contact to request) may drive change in overall outcome scores. Detailed examination of changes in specific social communication behaviors will promote better understanding of the influence of different interventions on child outcomes.

Short Play and Communication Evaluation: Teachers’ assessment of core social communication and play skills with young children with autism:

Children with autism spectrum disorder experience delays in the development of nonverbal social communication gestures to request and to share (joint attention) as well as play skills such that intervention is required. Although such tools exist in research settings, community stakeholders also require access to brief, simple, and reliable tools to assess students’ skills and set appropriate intervention targets. This study includes a sequence of two trials to examine implementation outcomes including adoption, fidelity, and feasibility of The Short Play and Communication Evaluation by educational professionals who work with preschoolers and toddlers with autism spectrum disorder in low-resource community classrooms. Findings demonstrate that classroom staff can deliver the Short Play and Communication Evaluation with high fidelity, collect live data, and set appropriate social communication and play skill targets for use in intervention. Furthermore, study 2 demonstrates that modifications to the study protocol resolved differences in children’s skill profile obtained from the established research measures.